The impact of measles immunization campaigns in India using a nationally representative sample of 27,000 child deaths

Abstract

India comprises much of the persisting global childhood measles mortality. India implemented a mass second-dose measles immunization campaign in 2010. We used interrupted time series and multilevel regression to quantify the campaign’s impact on measles mortality using the nationally representative Million Death Study (including 27,000 child deaths in 1.3 million households surveyed from 2005 to 2013). 1–59 month measles mortality rates fell more in the campaign states following launch (27%) versus non-campaign states (11%). Declines were steeper in girls than boys and were specific to measles deaths. Measles mortality risk was lower for children living in a campaign district (OR 0.6, 99% CI 0.4–0.8) or born in 2009 or later (OR 0.8, 99% CI 0.7–0.9). The campaign averted up to 41,000–56,000 deaths during 2010–13, or 39–57% of the expected deaths nationally. Elimination of measles deaths in India is feasible.

Seasonal variation and etiologic inferences of childhood pneumonia and diarrhea mortality in India

“…We identified pneumonia deaths from the MDS using ICD-10 codes A37, H65-H68, H70, H71, J00-J22, J32, J36, J85, J86, P23, and U04, and diarrhea deaths as codes A00 and A02-A09. We excluded 272 deaths from our pneumonia case definition and 132 child deaths from our diarrhea case definition which had a reported history of measles by the VA respondent, in an effort to minimize misclassification of deaths which may be secondary to a measles infection (Wong et al, 2019). We excluded an additional 557 child deaths due to typhoid or paratyphoid fever (ICD-10 code A01) from our diarrhea case definition, as these cases do not share a common symptom profile with other infectious causes of diarrheal disease (Morris et al, 2011).…”

“…Mortality among children aged 5–14 years is less well studied and recent estimates suggest a combined burden of almost 30,000 pneumonia and diarrhea deaths in India in 2016 (Fadel et al, 2019). The declines in pneumonia and diarrhea mortality during the last decade or so have mostly been driven by expanding treatment, improved nutrition, and vaccination against measles and standard childhood antigens (Bhutta et al, 2013; Wong et al, 2019). Newer vaccines such as rotavirus and pneumococcal conjugate vaccines have been only recently added to India’s Universal Immunization Program (Arora and Swaminathan, 2016; Sachdeva, 2017).…”

Socio-demographic correlates of first dose of measles (MCV1) vaccination coverage in India

“…The government of India introduced the MCV2 in 2010 among all the states and union territories in various phases. Surveillance-based studies in different areas in India have demonstrated positive correlations with optimal MCV2 vaccination and reduced rates of measles-related mortality [23][24][25][26].…”

“…Following the successful implementation of the 2017 measles and rubella campaigns the confirmed measles cases in India dropped to 10,695. Earlier measles vaccination campaigns in India, such as the 2010 two dose measles campaign are estimated to have saved the lives of 41,000–56,000 children between 2010 and 2013 — equivalent to 39–57% of the expected number of measles deaths nationwide [ 26 ]. Despite the remarkable progress in measles control, India still has the fourth highest measles caseload globally [ 12 ].…”

Reducing measles mortality in India

“…Now, in eLife, Prabhat Jha of the University of Toronto and colleagues – including Benjamin Wong as first author – report how they were able to assess the full impact of this enormous immunization campaign (Wong et al, 2019). Wong et al used data from the Million Death Study, which systematically ascertains the cause of death in a nationally representative sample of deaths in India, including 27,000 child deaths from 1.3 million households between 2005 and 2013 (The Million Death Study Collaborators, 2010; Fadel et al, 2017; Gomes et al, 2017).…”